Article viewed 32 times

23 Jul 2025
Add to Bookmarks


 

Aseptic Hypertrophic Non-union of Periprosthetic Femur Fracture

Score and Comment on this Case

Select a Score out of 10, and add a comment in the field below

Respectfully consider international variabilty in surgical technique and implants when commenting.
Protected by reCAPTCHA - Privacy and Terms


Clinical Details

Clinical and radiological findings:  A 67-year-old female presented with persistent and worsening thigh pain 15 months following open reduction and internal fixation (ORIF) of a periprosthetic femur fracture performed at an outside facility. Prior to the femur fracture, the patient's hip and knee prostheses were functioning well without pain. There was no history of postoperative infection. Radiographic evaluation and clinical presentation classified the non-union as aseptic and hypertrophic, indicating significant biological activity but inadequate mechanical stability at the fracture site.

Preoperative Plan

Planning remarks:  The preoperative plan involved restoring the anatomic axis, achieving mega compression, and ensuring absolute stability of the fracture site. The existing short plate with minimal proximal segment fixation was identified as insufficient, necessitating revision with improved fixation strategy.

Surgical Discussion

Patient positioning:  The patient was positioned supine on the operating table, with the affected limb prepared for surgical access.

Anatomical surgical approach:  A lateral approach to the femur was utilized, with careful dissection through the fascia lata to expose the previous surgical site. The existing hardware was assessed, and the non-union site was visualized without disturbing the biological activity present.

Operative remarks: 

The surgeon noted that the hypertrophic non-union was primarily due to inadequate proximal fixation in the initial surgery. The revision strategy focused on enhancing mechanical stability through extended fixation and compression techniques. No augmentation of the biological environment was deemed necessary due to the presence of active callus formation.

Postoperative protocol:   Postoperative rehabilitation included protected weight-bearing with gradual progression to full weight-bearing as tolerated, focusing on maintaining range of motion and strength in the surrounding musculature.

Follow up:   Not specified

Orthopaedic implants used:   Not specified

Search for Related Literature

Powered by OrthoSearch - The British Editorial Society of Bone & Joint Surgery


#

orthopaedic_trauma
  • United States , Seattle
  • Area of Specialty - General Trauma
  • Position - Specialist Consultant
#
Industry Sponsership

contact us for advertising opportunities


Peer Review Score

Average Score based on 0 reviews

Catalogue Index